The Virtual Dermatology Pilot

When a patient recently came in with a growth on her finger that was bleeding, Ginny Sugimoto, MD, could have referred her to a dermatologist.

Instead, Dr. Sugimoto, a family physician at Group Health Medical Centers Port Orchard clinic, had her nurse take a photo of the finger, upload it into the patient's electronic medical record, include notes about the condition, and send it off with a request for a virtual dermatology consult. Within hours, a dermatologist reviewed the photo and the patient's medical record, and recommended that the patient be seen right away.

Speedy Consultations

Being able to triage patients — decide what cases can wait and which need to be seen right away — is one of the benefits of a teledermatology pilot project underway at several Group Health clinics, including Port Orchard, Silverdale, Poulsbo, Lynnwood, Redmond, and Olympia.

"In dermatology, a picture is worth a thousand words," says Dr. Sugimoto. It's not unusual for a dermatologist to be able to make a diagnosis based on a photo, especially where rashes are concerned.

"Teledermatology allows us to render an opinion within hours," says Robert Butler, MD, a Group Health dermatologist who is participating in the pilot. "Many patients are getting their rash diagnosed and a treatment plan in hours, rather than having to wait one or two months for a dermatology appointment." In those cases, the patient also is saved from traveling to a second appointment and paying another copay. "If the patient does need to be seen, we can give them the right kind of appointment, at the right time," notes Dr. Butler.

That's often what happens where skin lesions are concerned. "When something like skin cancer is suspected, it's much harder to give a 'yes' or 'no' based on a photo," says Andrew Shors, MD, Group Health chief of dermatology. In those cases, patients are referred for a dermatology appointment.

How it Works

The teledermatology pilot has just a few requirements. A digital camera is needed, though not a fancy one, and a nurse or medical assistant has to receive a small amount of training in how to use it and upload an image into a patient's electronic medical record. The primary care physician must request a consult and include notes about the patient's condition. And a few dermatologists must allow time in their schedules each day to review the virtual consult requests.

One of the goals of the pilot is to improve access to dermatology. A dermatologist can probably complete two or three virtual consults in the time it would take to complete one office visit, says Dr. Butler. While it's too soon to know how many more patients are being seen in dermatology as a result of the pilot, the program is showing many signs of success. "Patients love it," says Dr. Sugimoto. "And it's good for primary care physicians. We get confirmation on a diagnosis, and we learn different approaches to treatments. We have great dermatologists, and we've learned a lot from them."

There isn't a timetable for when teledermatology will be available at all Group Health clinics. That decision is pending a thorough evaluation of the pilot. "I'm sure it will spread," says Dr. Shors. "It's more a question of, what's the best use for this?"